Richard Cunningham, MD is a board certified orthopedic surgeon and sports medicine specialist with over twenty years of orthopedic surgery experience. Dr. Cunningham and his team believe that the postoperative period very important for an optimal outcome. This period of the partnership between the patient and your surgeon is essential. As such, knowing what to expect following orthopedic surgery is key.

Start With Accurate Expectations

Dr. Cunningham’s patients are presented with a treatment plan that includes detailed expectations throughout the recovery. The elements to achieve this involve the following:

Diagnosis – An accurate diagnosis sets the course for expectations. Determining the nature of an orthopedic condition requires a thorough evaluation. A patient’s history,  physical examination, and any imaging, will provide the information needed to establish the diagnosis and develop a treatment plan. An accurate diagnosis is enhanced by the level of experience of the physician. Seeing and treating thousands of patients with similar conditions help inform the diagnosis. Patients benefit from Dr. Cunningham’s  experience and expertise. Once an accurate diagnosis is determined, together with the surgeon the patient, will discuss treatments and expectations.

Treatment – There are a range of non-surgical and surgical options for different orthopedic conditions. The doctor will explain the various options and clearly outline what is involved in the specific treatments. Together, the optimal choice is made between the patient and the surgeon. The patient will be required to follow pre-surgical instructions in the weeks, days and night before treatment. On the day of surgery, Dr. Cunningham and his medical team make this part of the journey as easy for the patient as possible.

Know The Post-Surgical Process

Dr. Cunningham’s patients are fully informed of the critical role they play in the post surgical process. Being informed is key to achieving optimal results.

Follow-Up Appointments – Most orthopedic surgeries require monitoring for 12-20 weeks after treatment. There is a typical schedule:

• 1-2 weeks: Plan to come into the office in order to check your wound, range of motion, and possibly get x-rays, as well as get your questions answered.
• 6 weeks: the focus of this visit is typically to be sure your range of motion is one track. Xrays may be obtained if you are being treated for a fracture. This may be the visit where a knee brace or shoulder sling can be discontinued.
• Twelve weeks (dependent on type of surgery)

Patients should contact the doctor with questions or concerns at any point in the process. Telemed appointments may be provided in cases where an in-office visit is not possible.

Initial Post-Operative Care – Patients must follow post-operative care instructions carefully. This will involve:

• Wound dressing changes
• Suture/staple monitoring
• Bathing restrictions
• Elevation
• Ice therapy
• Compression

Wound dressing changes – This is done with materials and instructions provided at discharge. The most common orthopedic surgeries involve the knee or shoulder. Know what to expect with wound dressing changes in either case:

Knee: The first dressing change for a knee surgery will occur 3 days after your surgery. The ACE bandage should be removed as well as all gauze and disposed of. Feel free to shower at this point. Please do NOT soak the knee in any bathtub, pool, hot tub, etc. until advised. The white tape strips over your incisions should remain on until your follow-up visit (or until 10-14 days).

• The Tubigrip (tan) sleeve is used to hold the gauze pads in place
• Change the gauze pads after EVERY shower until there is no further bloody drainage from the wound.
• DO NOT remove, or apply ointment to the tape strips over the incisions
• These will be removed at your first follow-up appointment
• If they fall off before your appointment, please reapply them with the extras provided to you

Shoulder: The first dressing change for a shoulder surgery will occur 3 days after your surgery. The bandage on your shoulder should be removed as well as all gauze and disposed of. The white tape strips over your incisions should remain on until your follow-up visit (or until 10-14 days). Place the waterproof bandages (Op-Sites) on top of the tapes, covering all incisions. Feel free to shower at this point. Keep your surgical arm by your side while showering and use the other arm to shower. You can bend over to allow your surgical arm to gently fall away from your body to wash under your arm. Please do NOT soak the shoulder in any bathtub, pool, hot tub, etc. until advised.

At the time of each dressing change, evaluate the incision for signs of infection. Signs and symptoms are:

• Purulent drainage
• Increasing redness surrounding the incision.
• Increased pain and swelling
• Fever or chills

Suture/staple monitoring – There are two types of sutures or staples:

Dissolvable: These look like clear fishing line. They require no care. Some incisions may have suture “tails” or sutures at either end sticking out of the skin an inch or so. At the first post-op appointment, the “tails” will be clipped at the skin level. All suture material below the skin will gradually resorb.  For out of town patients, suture tails can be done with fine scissors or small fingernail clippers.

Removable Sutures or Staples: If blue or black sutures or shiny metal staples were used to close your incision, they will be removed at 10-14 days from surgery by the clinic staff or your doctor at home. The staples need to be removed using a special staple remover. The sutures need to be removed using a sterile suture removal kit. Please do not try to remove them at home on your own unless instructed to do so.

Bathing restrictions – In order to prevent infection, follow the bathing protocol provided. It may include:

• Keep the incision dry at all times for the 3 days
• Change gauze pads after each shower until there is no further bloody drainage
• Change the Op-Site (waterproof dressing) every 3 days for a shoulder surgery until there is no longer any bloody drainage.

Avoid baths and swimming pools for the first two (2) weeks.

Elevate – Elevate the operative body part whenever possible. Elevation means the operative region is higher than your heart.

Ice – Ice the surgical site at least 3-4 times a day for 20 minutes at a time. Ice more than this but be sure that the skin is not getting too cold (especially if you have had a nerve block and the sensation is compromised). Motorized cooling device (arranged before surgery), ice bags, freezer wraps, or even frozen peas are options. When icing, have a protective layer between the skin and the ice. Be very diligent with icing. Check the skin to be sure it is not getting injured (frostbite) by the ice.

Knee Patient Note – Knee surgery requires additional post surgical care for risk of blood clots.

• Know the signs and symptoms of blood clots. Pain, commonly, cramping pain (like a Charlie horse) and swelling in the calf and lower leg should trigger an IMMEDIATE call to the doctor.
• Blood clot prevention is recommended for both legs. Special stockings, known as thromboembolism-deterrent (TED) hose, should be worn on both the treated and untreated leg as much as possible, to control swelling and to decrease blood clot formation.

Ongoing Post-Operative Care – Following the initial period of post-operative care, there is a longer season of on-going patient process. It may include:

• Physical therapy
• Assisted devices
• Pain management
• Medication

Physical Therapy – Patients will be given specific exercises to follow, beginning as soon as the surgeon recommends, as well as at different time frames during rehabilitation. Often, range- of-motion movements will be prescribed right away. These movements are used to minimize swelling and reduce scar tissue formation. Follow these instructions carefully. Do not advance, or let the Physical Therapist advance the physical therapy treatment beyond the normal time frames unless directed so by the surgeon. Physical therapy prescription, with instructions, will be provided when indicated.

Assisted Devices – Patients may require assistance devices to promote recovery. Crutches help alleviate weight bearing for lower extremity surgeries. A brace can help stabilize and compress the operative area. A sling will support, limit and stabilize an upper extremity. Patient instructions as to duration, frequency and proper use should be followed carefully.

Pain Medication – Typically, post-operative pain medications are prescribed beforehand. Pain medications may include MS Contin (Morphine Sulfate)  / Percocet / Oxycodone / Vicodin / Norco / Dilaudid. These are controlled substance narcotics that help control  pain. These narcotic pain medications cannot be called into the pharmacy. A hard copy prescription must be presented in person. Plan appropriately to fill it.  Refills will be authorized only as necessary.

Remember responsible use of narcotics. Do not mix with alcohol or marijuana. Do not drive. Do not take additional acetaminophen.

Other Medications – For a range of needs, patients may also be prescribed the following.

Valium (Diazepam) – is a Benzodiazepine for muscle spasms and helps to relieve anxiety and insomnia

Flexeril (Cyclobenzaprine) – is a muscle relaxant use to decrease muscle spasms

Aspirin – Take one 81mg aspirin daily for two (2) weeks following knee surgery to thin the blood unless otherwise advised. Please let Dr. Cunningham’s team know if you have ever had a blood clot or have a strong family history of clotting.

Multivitamin– A daily Multivitamin should be taken to help ensure you get the correct nutrition to help your body heal after surgery.

Colace (Docusate Sodium) – A stool softener that can be purchased over the counter to help relieve constipation which commonly occurs when taking narcotic pain pills. Over the counter laxative (MiraLAX, Milk of Magnesia) may also be used for more severe constipation.

Zofran (Odansetron) – A nausea medication. Please follow instructions regarding proper use

Scopolamine patch – A nausea medication. It generally lasts 3 days long and is a patch that you should place behind your ear. Often, if you have a history of postoperative nausea, this is given prior to surgery. We ask that you put the patch on the night prior to your surgery. This will assist with decreasing your nausea following surgery.

Adjust The Lifestyle / Extend the Benefits

Extend the surgical benefits by considering lifestyle modifications. Commit to strength, balance and motion training programs. Remain in contact with the orthopedic medical team with any changes that occur.

Lifestyle Adjustments – A patient’s clear-eyed review of lifestyle choices, with a focus on areas for improvement, is a great way to readily meet post-surgical expectations. Consider these healthy lifestyle questions.

• Age
• Current physical health
• Body weight
• Bone health
• Nutrition habits
• Sleep hygiene
• Tobacco, alcohol, and other substance use
• Stress level
• Social, physical, and recreational choices
• Mindfulness
• Positive perspective
• Fitness priorities

In examining current practices around these key health indicators, determine areas of improvement and set on a course to build improved lifestyle choices. These improvements will support a long term optimal surgical outcome, a winning strategy.

Commit to fitness – Patients enhance surgical outcomes by committing to a strength, balance and motion training program. No matter the pre-surgery fitness level, there is room for growth. Fine tune it to personal likes and time commitment in order to maintain motivation and persistence. Set goals, and be sure to include strengthening, balance and movement. Consult with the physical therapist or sports medicine specialist for target improvements. It can be motivating to chart progress and reward effort. Use visualization, the buddy system, and how good it feels to maintain commitment. Optimal surgical results will be the reward.

Check In With Your Orthopedic Doctor – Listen to the body. Pay attention to how it handles and responds to various activities. Allow time for recovery from more strenuous activities, and pay attention to the return to a base line of movement, range of motion and freedom from pain. If something begins and does not resolve in the typical time frame, reach out to the medical team. Staying in touch with your orthopedic team is one of the most successful ways to ensure the surgical repair continues to provide optimal results, and prevent any unexpected loss or new damage to the area.

Contact Richard Cunningham, MD for more information about what to expect after orthopedic surgery. For our Vail, CO office call (970) 476-7220. For Frisco, CO call (970) 569-3240.